Bates’ Visual Guide to Physical Examination

Volume 2: 2.2 General Survey and Somatic Growth Video Transcript

Narrator: With the patient’s health history in mind and after good hand hygiene, you are ready for the physical examination.

Examine the infant in the presence of the parents as parents can often help to calm a restless or screaming baby. You can examine the infant in the parent’s lap if needed, but an examination table or create is optimal. Perform a general survey, inspecting the patient closely literally from head to toe in order to form impressions for your written assessment.

During the general survey, observe the quality of parent/child interactions. Also look for signs of stress or depression in parents, which may place the child at risk and sometimes can indicate an increased risk for child abuse or neglect. Approach the infant gradually, using a toy or object for distraction. Speak softly to the infant or mimic the infant’s sounds to attract attention. Don’t expect to do a head-to-toe exam in a specific order. Take what the infant gives you and save the mouth and ear exam for last. In general, you will perform non-disturbing maneuvers early in the examination and potentially distressing maneuvers near the end.

Follow the general survey with an assessment of somatic growth. Growth is one of the most important indicators of a child’s health, and deviations from normal may be an early sign of an underlying problem. When assessing growth, compare your findings with normal values according to the child’s age and sex. The most important tools for assessing somatic growth our growth charts. Growth charts display a series of lines that enable you to establish percentile rankings for your patience, indicating their growth relative to other children of the same chronologic age.

For safety reasons, it is recommended that pediatric examination tables be placed flush against the examination room wall. For the infant, height is measured as body length. Direct measurement using a tape measure is inaccurate. For a more accurate measurement, place the baby supine on a measuring board or tray, holding the patient is still with hips and knees fully extended. Weigh infants directly within infant scale. Infants should be naked or clothed only in a diaper in which case the diaper should be weighed separately and that weight subtracted from the overall measurement.

Head circumference should always be measured during the first two years of life. This measurement reflects the rate of growth of the cranium and the brain. Place a measuring tape over the occipital, parietal and frontal prominences to obtain the maximum circumference.